Alamo J M, Gómez M A, Pareja F, Martínez A, López F, Romero E, Barrera L, Serrano J, García I, Bernardos A
Liver Transplantation Unit, Surgery Department, Virgen del Rocío Hospital, Seville, Spain.
Transplant Proc. 2006 Oct;38(8):2475-7. doi: 10.1016/j.transproceed.2006.08.056.
The incidence of orthotopic liver retransplantation (re-OLT) ranges from 6% to 11%. The most frequent causes of early re-OLT are allograft failure, uncontrolled acute rejection, and vascular complications.
A retrospective study of 512 orthotopic liver transplants (OLTs) in 482 patients over 15 years.
The incidence of re-OLT was 6.6%, with a higher percentage of men requiring re-OLT than first-time OLT (75.0% vs 63.0%, P < .05). The reasons for re-OLT were thrombosis 21.7%, aneurysm 6.5%, stenosis 3.2%, primary nonfunction (PNF) 21.7%, and chronic rejection or recurrence of the initial disease 40.4%. Complications included PNF (22.0%), acute renal failure (65.6%), postoperative infection (87.5%), and adult respiratory distress syndrome (9.4%; P < .05). No differences were seen in the incidence of septicemia or postoperative hemorrhage. The average survival was much lower in re-OLT (21.8 days) compared with OLT (194.5 days; P < .05). The mortality rates in re-OLT were 100% for primary biliary cirrhosis, 85.7% for HCV, 50% for alcoholic cirrhosis, and 20% for HBV. A direct association between the Model for End-stage Liver Disease (MELD) score and the number of complications was present.
There was a greater requirement for re-OLT in men and those patients transplanted due to hepatitis B virus cirrhosis and fulminant hepatitis (P < .05). The re-OLT patients had no greater incidence of sepsis compared with the OLT patients, although they did have a greater incidence of primary graft dysfunction, acute renal failure, adult respiratory distress syndrome, and postoperative infection (P < .05). The MELD was a good parameter for predicting graft evolution. Re-OLT in patients with primary biliary cirrhosis and hepatitis C virus was associated with a high degree of mortality.
原位肝再次移植（re-OLT）的发生率在6%至11%之间。早期再次肝移植最常见的原因是移植物功能衰竭、无法控制的急性排斥反应和血管并发症。
对482例患者在15年期间进行的512例原位肝移植（OLT）进行回顾性研究。
再次肝移植的发生率为6.6%，需要再次肝移植的男性比例高于首次肝移植（75.0%对63.0%，P<.05）。再次肝移植的原因包括血栓形成21.7%、动脉瘤6.5%、狭窄3.2%、原发性无功能（PNF）21.7%以及慢性排斥反应或初始疾病复发40.4%。并发症包括原发性无功能（22.0%）、急性肾衰竭（65.6%）、术后感染（87.5%）和成人呼吸窘迫综合征（9.4%；P<.05）。败血症或术后出血的发生率未见差异。再次肝移植患者的平均生存期（21.8天）远低于肝移植患者（194.5天；P<.05）。原发性胆汁性肝硬化患者再次肝移植的死亡率为100%，丙型肝炎患者为85.7%，酒精性肝硬化患者为50%，乙型肝炎患者为20%。终末期肝病模型（MELD）评分与并发症数量之间存在直接关联。
男性以及因乙型肝炎病毒肝硬化和暴发性肝炎接受移植的患者对再次肝移植的需求更大（P<.05）。再次肝移植患者的败血症发生率与肝移植患者相比并无更高，但他们原发性移植物功能障碍、急性肾衰竭、成人呼吸窘迫综合征和术后感染的发生率确实更高（P<.05）。MELD是预测移植物转归的良好参数。原发性胆汁性肝硬化和丙型肝炎病毒患者的再次肝移植与高死亡率相关。
